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      Predictors of Initiation for Predialysis Arteriovenous Fistula

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          Abstract

          Background and objectives

          The optimal timing of predialysis arteriovenous fistula surgery remains uncertain. We evaluated factors associated with hemodialysis initiation in patients undergoing predialysis arteriovenous fistula surgery and derived a model to predict future initiation of dialysis.

          Design, setting, participants, & measurements

          Our study retrospectively identified 308 patients undergoing predialysis arteriovenous fistula creation at a large medical center in 2006–2012 to determine whether they initiated hemodialysis. Multiple variable logistic regression analyzed which demographic and clinical factors predicted initiation of dialysis within 2 years of arteriovenous fistula surgery. A receiver operating characteristic area under the curve was used to quantify the predictive value of preoperative factors on the likelihood of initiating hemodialysis within 2 years.

          Results

          Overall, hemodialysis was initiated within 6 months, 1 year, and 2 years in 119 (39%), 175 (57%), and 211 (68%) patients, respectively. Using multiple variable logistic regression, four factors were associated with hemodialysis initiation at 2 years: eGFR at access surgery (odds ratio, 0.45; 95% confidence interval, 0.31 to 0.64 per 5 ml/min per 1.73 m 2; P<0.001), diabetes (odds ratio, 2.51; 95% confidence interval, 1.22 to 5.15; P=0.003), GFR trajectory (odds ratio, 1.54; 95% confidence interval, 1.09 to 2.17 per 3 ml/min per 1.73 m 2 per year; P=0.01), and spot urine protein-to-creatinine ratio (odds ratio, 1.39; 95% confidence interval, 1.14 to 1.71 per 1 U; P<0.001). eGFR alone had a moderate predictive value for dialysis initiation (area under the curve =0.69; 95% confidence interval, 0.63 to 0.76; P<0.001), whereas the full model had a higher predictive value (area under the curve =0.83; 95% confidence interval, 0.77 to 0.88; P<0.001).

          Conclusions

          The likelihood of initiating hemodialysis within 2 years of predialysis arteriovenous fistula surgery is associated with eGFR at access surgery, diabetes, GFR trajectory, and magnitude of proteinuria. The combined use of all four variables improves the ability to predict future hemodialysis compared with the use of eGFR alone.

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          Author and article information

          Journal
          Clin J Am Soc Nephrol
          Clin J Am Soc Nephrol
          clinjasn
          cjn
          CJASN
          Clinical Journal of the American Society of Nephrology : CJASN
          American Society of Nephrology
          1555-9041
          1555-905X
          7 October 2016
          14 September 2016
          : 11
          : 10
          : 1802-1808
          Affiliations
          [* ]Department of Medicine and Division of Nephrology and
          []Department of Surgery and Division of Transplantation, University of Alabama at Birmingham, Birmingham, Alabama;
          []Division of Nephrology, Veterans Affairs Medical Center, Birmingham, Alabama; and
          [§ ]Department of Microbiology, Montana State University, Bozeman, Montana
          Author notes
          Correspondence: Dr. Michael Allon, Division of Nephrology, University of Alabama at Birmingham, Paula Building 226, 1530 3rd Avenue South, Birmingham, AL 35294-0007. Email: mdallon@ 123456uab.edu
          Article
          PMC5053781 PMC5053781 5053781 00700116
          10.2215/CJN.00700116
          5053781
          27630181
          Copyright © 2016 by the American Society of Nephrology
          Page count
          Figures: 3, Tables: 4, Equations: 0, References: 23, Pages: 7
          Categories
          Original Articles
          ESRD and Chronic Dialysis
          Custom metadata
          October 07, 2016

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